SummaCare Quartz (HMO) vs. Topaz (HMO) – Key Differences Explained

With some of the changes in SummaCare’s 2027 Medicare Advantage plans, you may be wondering which one is best for you. Here’s a comparison of two of our most popular plans – Quartz (HMO) and Topaz (HMO).

The $0 Quartz plan (beyond your standard Medicare Part B premium) is perfect for those who are budget-conscious and prefer to pay no premium. Topaz, at $17 per month, is ideal for health-conscious individuals who value lower out-of-pocket expenses and want richer supplemental benefits.

With both plans, you get a lot of benefits at no added cost, including:

• $0 Primary care provider (PCP) visits
• $0 Copay on preventive dental, preventive hearing and vision exams
• $0 Dental cleanings, fluoride treatment, X-rays and exams
• $0 Copay for tier 1, 2 and 6 drugs at preferred pharmacies

But there are some differences, too.

• Both plans offer built-in protection with an annual out-of-pocket maximum for in-network services. Topaz members’ out-of-pocket max is $4,650, while Quartz members’ is $5,200.
• Members of both Topaz and Quartz can get diagnostic procedures and tests from $0 to $125. Lab services range from $0 to $10 for Topaz members and $0 to $15 for Quartz members.
• Members receive an over-the-counter (OTC) quarterly allowance through SummaCare’s &more card to use at in-network retailers nationwide. Topaz members get $40 per quarter and Quartz members get $25 per quarter.
• On both plans, members pay the full cost of tier 3, 4 and 5 drugs until you reach the plan’s deductible. Part D deductible for Topaz members is $365, while for Quartz members it is $410.
• Members of both plans get an annual vision hardware allowance with freedom to purchase anywhere – Topaz members get a $200 allowance, while Quartz members get $100 allowance.

If dental coverage is a strong consideration for you, you’ll want to know the differences. Both plans include dental coverage, but the benefits are different.

• With Topaz, your dental max is $3,000. You’re fully covered for fillings, simple extractions and root canals; and covered up to 20% for bridges, crowns and dentures.
• With Quartz, you have a $2,000 dental max. You’re covered up to 50% for fillings, simple extractions and root canals; and you have 70% coverage for bridges, crowns and dentures.
• Think you may need even more dental coverage? Members may purchase optional supplemental dental coverage for an additional $38 monthly premium. This coverage offers access to a broader dental network (PPO and Premier networks) and includes additional covered services beyond the embedded dental benefit. It also provides a lower cost share on bridges, crowns and dentures on Quartz.

As a member of both plans, you’ll also enjoy:

• Coverage when you travel to any Medicare-approved provider in Arizona, Florida, North Carolina, South Carolina and Texas – ideal for snowbirds!
• Worldwide emergency, urgent care coverage and ambulatory services
• A vast network with more than 26,000 providers and 80 hospitals
• Hearing aid coverage that includes one hearing aid for each ear every year (with applicable copays)
• Over the counter (OTC) quarterly allowance through SummaCare’s &more card to use at in-network retailers nationwide

You’ll also gain access to extras to support your health and help you stay active:

• Fitness benefit – Your SilverSneakers® gym membership provides access to thousands of participating in-person gyms nationwide, a fitness app to access fitness programs on the go, plus On-Demand video workouts that let you work out comfortably at home
• Telehealth and 24/7 nurse line — Visit with your primary care provider, specialists or behavioral health specialists online plus get access to 24/7 nurse support
• Chronic condition support — Get no-cost tools and resources to help you manage chronic conditions including diabetes, depression, heart or kidney conditions or asthma

As you can see, Quartz gives you a lot of benefits for $0. With Topaz’s low $17 monthly premium, you’ll have lower out-of-pocket expenses and even more supplemental benefits. For many members, that added coverage can provide valuable financial protection and greater peace of mind throughout the year.

The choice is yours – and we’re here to help you make the right one. To learn more about SummaCare’s Quartz (HMO) and Topaz (HMO) plans, contact a SummaCare Medicare Advantage Advisor at 888.464.8440 or visit summacare.com/medicare to compare plans.

SummaCare is an HMO and HMO-POS plan with a Medicare contract. Enrollment in SummaCare depends on contract renewal. Other providers are available in our network. This information is not a complete description of benefits. Call 888.464.8440 (TTY 711) for more information. &more Benefits Prepaid Mastercard® is issued by Avidia Bank, pursuant to a license from Mastercard Incorporated. Use of this card is subject to the terms and conditions of the Cardholder Agreement. H3660_SCMCWeb_M